Hypnotics

Question 1

before hypnotic is prescribed for insomnia, you need to

Answer 1

establish the cause of insomnia and where possible treat underlying factors

Question 2

be aware of the following - some patients have ………
and others understate their ….. consumption

Answer 2

some patients have unrealistic sleep expectations, and others understate their alcohol consumption which is often the cause of the insomnia

Question 3

what type of hypnotics are preferable in pt with sleep onset insomnia (difficulty falling asleep), when sedation the following day is undeniable or when prescribing for elderly ?

Answer 3

short acting

Question 4

what type of hypnotic is indicated in pt with poor sleep maintenance (e.g. early morning waking) that causes daytime effects, when an anxiolytic effect is needed during the day, or when sedation the following day is acceptable

Answer 4

long acting

Question 5

you are prescribing a BZDPN for a pt who has early morning waking. what type of BZDPN would you prescribe

Answer 5

long acting

Question 6

Transient insomnia may occur in those who normally sleep well and may be due to extraneous factors e.g. …… (3)

If a hypnotic is indicated, what type and how many?

Answer 6

noise, shift work, and jet lag

one that is rapidly eliminated should be chosen, and only one or two doses should be given.

Question 7

short term insomnia is usually related to an emotional problem or serious medical illness. it may last ….

Answer 7

few weeks, may recur

Question 8

short term insomnia is usually related to …

Answer 8

an emotion problem or serious medical illness

Question 9

in short term insomnia, a hypnotic can be useful but should not be given for more than…

which type of hypnotic is preferred
and how should it be used

Answer 9

3 weeks (pref 1 week)
A short-acting drug is usually appropriate. Intermittent use is desirable with omission of some doses.

Question 10

does chronic insomnia benefit from hypnotics

Answer 10

rarely

Question 11

sometimes, chronic insomnia is due to mild dependence caused by ..

Answer 11

injudicious prescribing of hypnotics

Question 12

common causes of chronic insomnia

Answer 12

Psychiatric disorders such as anxiety, depression, and abuse of drugs and alcohol

Question 13

sleep disturbance is very common in depressive illness. the following sign is a characteristic one of depression

Answer 13

early wakening

Question 14

Sleep disturbance is very common in depressive illness and early wakening is often a useful pointer. The underlying psychiatric complaint should be treated, adapting the drug regimen to alleviate insomnia. For example, the following two drugs prescribed for depression will also help to promote sleep if taken at night

Answer 14

clomipramine
mirtazapine

Question 15

tolerance to the effects of hypnotics develops with …. days of continuous use and long term efficacy cannot be assured

Answer 15

3-14 days

Question 16

what is a major drawback of long term use …..

Answer 16

withdrawal can cause rebound insomnia and a withdrawal syndrome

Question 17

Where prolonged administration is unavoidable hypnotics should be discontinued as soon as feasible and the patient warned that sleep may be disturbed for a few days before normal rhythm is re-established; the following sleep disturbance may persist for several weeks

Answer 17

broken sleep with vivid dreams may persist for several weeks.

Question 18

why should BZDPNs and Z drugs be avoided in elderly

Answer 18

greater risk of becoming ataxic (poor muscle control that causes clumsy movements) and confused
leading to falls and injury

Question 19

Some anxious patients may benefit from the use of hypnotics during dental procedures such as (2)

….. is preferred when it is important to minimise any residual effect the following day

Answer 19

diazepam, temazepam

Temazepam is preferred when important to minimise any residual effect the following day

Question 20

Name 2 long acting BZDPNs that are used as hypnotics. Since they are long acting, they may give rise to residual effects on the following day; repeated doses tend to be cumulative

Answer 20

nitrazepam
flurazepam

Question 21

Name 3 BZDPNs that are short acting and used as hypnotics. They will have little or no hangover effect, however withdrawal phenomena are more common

Answer 21

loprazolam, lormetazepam, temazepam

Question 22

withdrawal phenomena are more common with …-acting BZDPNs

Answer 22

short

Question 23

If insomnia is associated with daytime anxiety then the use of a …….-acting benzodiazepine anxiolytic such as ….. given as a single dose at night may effectively treat both symptoms

Answer 23

LONG acting
diazepam

Question 24

where do the Z drugs act

Answer 24

at the BZDPN receptor

Question 25

do the Z drugs have a long or short duration of action

Answer 25

short

Question 26

explain why clomethiazole may be a useful hypnotic for elderly patients

Answer 26

short acting - no hangover effect
however routine admin still undesirable as with all hypnotics
also dependence occurs

Question 27

name an antihistamine which is on sale to the public for occasional insomnia

Answer 27

promethazine HCl

Question 28

Some antihistamines such as promethazine hydrochloride are on sale to the public for occasional insomnia. What is its duration of action? and what is the licensing OTC?

Answer 28

Prolonged so often cause drowsiness the following day

For short term use in the treatment of insomnia in adults and as a sedative in children over 16 years of age. Take 25mg or 50mg at night. Max 7 days. Avoid alcohol.

Qt!! Do not use in p or bf.

Question 29

Why is alcohol a poor hypnotic

Answer 29

diuretic action interferes with sleep during latter part of night
alcohol also disturbs sleep patterns, and so can worsen sleep disorders

Question 30

Name the organ in the cerebrum that produces the hormone melatonin

Answer 30

pineal

Question 31

Melatonin - licensed for the following

(3)

Answer 31

Short term treatment of insomnia in adults over 55
Short term treatment of jet lag in adults
Insomnia in patients with learning disabilities and behaviour that challenges [where sleep hygiene measures have been insufficient] (initiated under specialist supervision)